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KUESIONER SURVEI KEPUASAN MASYARAKAT
Lengkapi identitas berikut sebelum melanjutkan pengisian survei.
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* Indicates required question
Nama
*
Your answer
Nomor Hp
*
Your answer
Usia
*
Your answer
Jenis Kelamin
*
Perempuan
Laki-laki
Required
Pendidikan
*
SD
SMP
SMA
S1
S2
S3
Required
Pekerjaan
*
PNS
TNI
Polri
Swasta
Wirausaha
Other:
Required
Jenis Layanan yang Diterima
*
Loket
Farmasi
Poli KIA dan KB
Poli Anak
Poli Gizi
Imunisasi
Poli Umum
Poli Gigi
Laboratorium
Required
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